340B Drug Pricing Program Database
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DSH030002N Banner – University Medical Center Phoenix (Terminated)
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Main Details
Name
Banner – University Medical Center Phoenix
Subdivision Name
Toxicology Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH030002N
Medicare Provider Number
030002
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/15/2015
Participating Start Date
10/1/2015
Participating Approval Date
7/22/2015
Last Recertification Date
9/5/2019
Termination Date
Termination Reason
7/1/2020
Business decision by the Covered Entity
Contacts
Authorizing Official
BUMCP
Patricia Rhoden, Chief Financial Officer
(602) 839-8507
Primary Contact
Banner University Medical Center Phoenix
Jeff Anderson, Director, Pharmacy Academic
(602) 839-2657
Addresses
Street Address
1441 12th St 2nd Floor
PHOENIX, AZ 85006-2502
Billing Address
Banner University Medical Center Phoenix
1111 E McDowell Rd
Phoenix, AZ 85006
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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